Hyperdense middle cerebral artery sign among patients with severe ischemic attack on ultra-early phase

Objective: To detect the frequency of hyperdense middle cerebral artery sign(HMCAS) among patients with severe ischemic attack(baseline NIHSS score≥10) in the middle cerebral artery(MCA) territory within 3 hours after onset and compare the baseline characteristics and 90-day outcomes between the HMCAS(+) and HMCAS(-) groups.Methods: A total of 43 patients were evaluated with baseline clinical characteristics,laboratory tests and brain CT/MRI.Follow-up evaluation at the end of 90 days included the modified Rankin Scale(mRS),the Bathel Index(BI) and death.Results: Ten out of fourty-three(23.3%) patients were HMCAS(+).The 24-hour NIHSSS of HMCAS(+) group was significantly higher than that of HMCAS(-) group(20.2±5.4 vs.14.8±7.2,P= 0.037).The follow-up scanning confirmed that all HMCAS(+) patients had larger MCA territory infarction and the ratio of large MCA territory infarction was significantly higher than that of HMCAS(-) group(100% vs.39.1%,P = 0.001).There were no significant differences in age,gender,risk factors,time intervals,laboratory tests,90-day functional outcomes between the two groups.Conclusion: The HMCAS(+) patients had notable deterioration 24 hours after onset and had more severe MCA infarction.HMCAS detected by non-enhanced CT at admission should be considered as an alarming sign among patients with severe neurological deficit of MCA territory infarction.